First-line therapy for localized prostate cancer: outcomes and HRQOL

The decisions patients and their doctors make about which treatment to select as first-line therapy for localized prostate cancer are commonly based on perceptions and expectations about the side effects of these treatments, as well as on the curative potential of the therapy.

There has still only been one large, prospective, comparative study of the side effects of the major types of first-line treatment for localized prostate cancer, but a new, if smaller, study has now added to our knowledge.

Gore et al. have evaluated the health-related quality-of-life (HRQOL) outcomes of 475 patients for a period of 48 months after treatment for localized prostate cancer. All patients were evaluated before treatment and at 11 intervals during the 48 months afterintervention. The changes in mean HRQOL scores, and the probability of regaining baseline levels of HRQOL, were compared between treatment groups.

The basic results of the study are as follows:

  • Urinary incontinence was more common after prostatectomy (n = 307) than after brachytherapy (n = 90) or external beam radiation therapy (n = 78).
  • Urinary voiding and storage urinary symptoms were more common after brachytherapy than after prostatectomy.
  • Sexual dysfunction profoundly affected all three treatment groups, with a lower likelihood of regaining baseline function after prostatectomy than after external beam radiation therapy or brachytherapy.
  • Bowel dysfunction was more common after either form of radiation therapy than after prostatectomy.

These results appear to be similar in many ways to the data published in 2008 by Sanda et al. in their larger, prospective trial evaluating the same three forms of treatment, and there are no unexpected surprises in the new data, which seem to reflect expected norms.

Some additional comments about the study from Dr. Gore appear in a report on MedPage Today.

The abstract of the paper does not provide the details one might like to see: How many surgeons did the surgeries? Were all the patients T1-2? However, it is reasonable to assume that the patients all met certain pre-specified criteria for trial entry.

The authors suggest that their results may be able to help guide decision making for treatment selection and clinical management of patients with HRQOL impairments after treatment for localized prostate cancer. We would like to think that this might be the case, but we suspect that the well-understood specialty biases of different types of physician may tend to have greater influence on individual patients than these data.

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